IBM Medicare Via Benefits Extend Health Medicare Hospital Days Coverage

Medicare's hospital inpatient coverage is probably the least talked about topic in private insurance marketing campaigns.  That statement is true whether an insurance company is pitching a Medicare Supplement plan (aka medigap) or a Medicare Advantage plan.  Maybe it is not advertised because it is easier to understand copays for a doctor visit.  Mostly, it is too complex to describe in a 30 second ad or a flyer.

Nonetheless, it is the part of Medicare coverage that is the most expensive and if a Medicare consumer doesn't understand the structure it can have both financial and health treatment impacts that are life altering.

The Medicare agency government rules for hospital coverage are straight forward and all Medicare insurance must cover these benefits.  By law, the basic amount of hospital stay coverage is the same irrespective of what type of Medicare insurance:
   

1. There are 90 days of coverage in each benefit period.
         
2. A benefit period begins when the patient is admitted as an inpatient (so "observation" doesn't count as a hospital day).
        
3. A benefit period ends 60 days after the patient leaves the hospital.
         
4. If the patient needs more than 90 days in a hospital in a benefit period, they have an addition 60 "lifetime" days that they can use to extend the 90 day stay.  The "lifetime" number is 190 days if it is a psychiatric hospital.
         
5. If a patient is discharged from a hospital and not readmitted until 61 or more days later, the patient begins a new benefit period.
       

Here is what is not straight forward.  How much do you pay when admitted to the hospital as an inpatient and for hospital days?  What happens if you need more than 150 contiguous days (in the same benefit period) in the hospital because of a dire condition?  What happens if you are hospitalized 3 times in a given year and each time a new benefit period started because you were "out" more than 60 days before being readmitted?

The cost of a hospital stay very much depends on the kind of insurance you have.  It can actually be zero or many thousands of dollars. This is where it gets complicated.  But it's important to understand it. 

The only way to compare original Medicare with Medicare Advantage is to compare costs. To properly compare costs, original Medicare with a Medicare Supplement (aka medigap) are used in the table below.  I used a premium price that is typical for an "N" medigap plan and picked a real Medicare Advantage plan that had a $0 premium. Without a medigap, there is no cap on the annual cost a person can incur in original Medicare.  Medicare Advantage plans do have a cost cap (in 2019 the max can be as much as $6,700 for "in network" services and is the cap for the MA plan I picked).  That $6,700 can buy a very nifty medigap  which is why I am including medigap in this comparison. Also, whether you use original Medicare or a Medicare Advantage plan, you MUST always pay the "part B" fee (currently $135.50/mo). What follows are 2019 numbers:    

Phase	Original Medicare +  Medigap N at $150/mo	Sample MA plan $0 premium
Hospital Benefit period  (Every 60 days if discharged and out of hospital for 60 days)	$1364 deductible Medigap N pays deductible	$0 deductible
Hospital day copay per benefit period	$0 days 1-60  $341 days 61-90  $692 for 60 lifetime days Medigap N pays all the copays	$465 days 1-4 $0 days 5-90 $0 for 60 lifetime days
If exceed 150 days in hospital	All Medigaps provide the extra days benefit of 365 days at $0 copay	No Medicare Advantage plan has extra days benefit, must pay full day cost for days over 150
Maximum hospital  cost in 2019	Medigap premium x 12 (approx. $1800 for 2019)	$6,700 for 2019 (if do not exceed 150 days)

 

    

                                                                                                                            

  

IBM Medicare Via Benefits Extend Health Re-evaluate your part D or MA plan for 2020

Did you get the 2020 brochure for your current part D drug insurance or Medicare Advantage plan?  More importantly, DID YOU READ IT?
 
Actually, all you need to do is glance at it to decide if you need to read more.  I received my part D brochure last week.  Here's what I quickly saw for my plan - wow, the premium when down a few dollars.  But why?  I read on.
 
Let me count the ways:

1. The plan added a deductible.  For me, that's bad news because I would never meet the deductible based on my current drug use.  That means the only benefit I get from the plan is their "negotiated price" for the drug.  I'll have to pay full negotiated price in 2020 for my drugs unless I get new prescriptions.
       
2. The copays, once the deductible is met, increased for brand name drugs.  Again, it's bad news for me because, right now, I don't use generics for the drug I take.
       
3. It looks like the "network pharmacies" have also changed.  A local pharmacy is no longer on the list so I would need to remember to stay away from that pharmacy.
       
4. The brand name drug I take is only covered in the generic version.  I cannot use the generic version.  For some reason, the fillers cause it to work less well for me.
        

So, during open enrollment, I will pick a new plan for 2020.  Since Via Benefits sells a subset of the plans available in my zip code (typically, it is about half of the plans I could buy) I'll look on medicare.gov to pick the new plan and then see if Via Benefits sells it.  If not, just by enrolling in the new plan through medicare.gov, I'll be dis-enrolled from my current part D plan.  Then, I need to remember to file for reimbursement of premiums for that new part D plan in 2020.  

The reason I am easily able to change my part D without engaging Via Benefits is that I buy a Medicare Supplement through them.  Reminder - you only need to buy one medical policy from them to qualify for the HRA/FHA.

Changing a Medicare Advantage plan is more complicated.  If you want to change to a new MA plan for 2020, you have to do it through Via Benefit to continue to have access to your HRA/FHA.  Be sure you check with your doctors before changing to a new MA plan to be sure they will take the plan.

  

IBM Medicare Via Benefits Medicare Fall Enrollment for 2020

This is the time of year when you are being inundated with sales literature from private insurance companies trying to sell you Medicare Advantage plans and part D prescription drug insurance plans.  It is also the time of year when you receive plan updates from companies currently providing your Medicare insurance.  Sometimes it's hard to differentiate.  Usually, your current insurance providers send "thick" booklets to describe changes in premiums, copays, and changes in drug lists (known as their formulary).  You have to look at your mail! You have to keep the booklets about your current policies!

I cannot emphasize it enough. It is really, really important to not throw away the literature from your current insurance companies. You MUST read those "thick brochures" not only to look for changes to your existing policies but also because this is also the time of year insurance companies terminate plans and switch people automatically to another plan if the customer doesn't "take action" to actively pick a new insurance plan.

I have not had the experience, but my guess is that if you have an insurance policy purchased by using Via Benefits, they will tell you that you need to pick another plan. If it is the only plan you have with them, then you must pick a new medical plan that they sell (Medicare Advantage plan or part D drug insurance or Medicare Supplement plan) to have access to your HRA. Vision and Dental plans DO NOT qualify you for HRA access.

Reminder, if you have original/traditional Medicare and a Medicare Supplement through Via Benefits, you can buy any part D prescription drug insurance plan available in your zip code.  It doesn't have to be through Via Benefits.  There is a wide variation in the prices and formularies for part D plans.  Make sure you either use plan finder on www.medicare.gov to see if there is a better plan or call 1-800-MEDICARE and ask them for help to pick the best plan.

Given this is so complex, as we age, it is also really important to have someone else understand this process who can provide help if it becomes overwhelming.  Educate that person now because initially they will also be totally confused by the process.

Medicare (as in the federal government agency) schedules open enrollment every year to allow Medicare recipients to make insurance changes. It is akin to IBM's annual insurance enrollment when you were employed. This year the Medicare Open Enrollment (which is what the federal government calls it although sometimes it is referred to as Fall Enrollment) begins on October 15th and ends on December 7th and the changes are effective January 2020.  Reminder, this federal Medicare insurance change window only applies for Medicare Advantage plans and part D prescription drug insurance plans. 

Medicare Supplement plans (which are for people who have original/traditional Medicare) have completely different "change" rules and schedules.  In some states, you cannot change the insurance - NOT EVER - because insurance companies are allowed to deny policies to people with preexisting conditions or can charge whatever they want for the premium. At this age, it is rare for someone to not have preexisting aliments.  In some states, there are specific times of year (such as your birthday month) when you can change Supplement insurance but the premiums might be higher for a new policy if you have preexisting conditions.  In a few states, you can change the policy whenever you want and it must be sold at the same price that everyone else in the zip code pays plus you cannot be denied.  You have to check with your state to find out these rules.  There are state organizations that will help.  It is the State Health Insurance Assistance Program.  Each state has one.  To find your go to  https://www.shiptacenter.org/

IBM Medicare Via Benefits Extend Health "About Your Benefits Post Retirement" PDF

It is not easy to find a document that IBM publishes for retirees called "About Your Benefits Post Retirement".  It is on the NetBenefits site in the digital library.  A kind reader provided a link to the document in a reader comment.  Thank you! 

This document describes a wide range of topics for more than just health benefits for retirees.  It is particularly useful for people who have retired and are under 65 years old. There is some information about health benefits for retirees on Medicare.  The most important information for people using Via Benefits is how to complain to the Plan Administrator if you are having trouble dealing with Via Benefits.  It is buried in the back of the manual. It has been my experience that if you call the IBM Employee Service Center, they won't give you that information.  They will redirect you to file the complaint with Via Benefits. 

You must log on to the NetBenefits site to gain access to the most current version of the PDF before you use this link:  http://bit.ly/2UnEQxA

In case you want to read it, but don't want to log into NetBenefits, what follows is a link to a downloaded copy of the January 2019 version. IBM republishes this document from time to time.  If you need the most current version, log onto NetBenefits and use the above link. In this version, the description of how to complain about Via Benefits is on page 216:

https://drive.google.com/file/d/1j1OX3l3l_0xsnXYDtCDCjBcE4p3bfWlP/view?usp=sharing

To access this file you might have to download it.

IBM Medicare Via Benefits Extend Health Medicare.gov Plan search changes

The federal government has released a new version of the plan search function for open enrollment on www.medicare.gov.  This is the function that helps users decide which plan (part D or Medicare Advantage) to choose during open enrollment for 2020. The function is known as "plan finder". The federal government has said because of contractual problems with the company that maintained the previous version, the previous version will not be available after the end of September.  That is hard to believe. I think they just want to get rid of the old application because it doesn't push Medicare Advantage plans.

It is is the opinion of many people (including me) that the government is doing everything it can to push Medicare eligible recipients into Medicare Advantage plans using this new plan finder.  The new plan finder function also is pushing hard on users to "register" and use their Medicare account to store their prescription drug information to do plan searches.  That means the federal government will be able to collect even more data about Medicare recipients when it is stored in their personalized accounts.  The federal government has been notoriously bad about protecting user privacy, which means as users load their Medicare account with drug data, they increase exposure to hackers and/or scammers who, if successful in hacking, will know more about the drugs seniors take and be better able to convince seniors they are legitimate for whatever scam they are perpetrating. It might also be used by the government for other purposes, such as seeking geographic trends of drug usage to compare prescriptions for brand name versus generic and put pressure on insurance companies or even state legislatures to push generics (even if they don't work as well, aren't they good enough for old people?). Decide for yourself the amount of data you want to share. I will continue to use medicare.gov anonymously but found it took a lot of effort to get around the website incessant demands to log in.  Don't be intimidated by it!!  More importantly, use feedback to complain about it if you find it highly irritating.

The new plan finder function appears to require the use of a Medicare account but it doesn't.  If you don't want to use you account, just provide a random birth date when prompted for your birthday and don't log into your account. Also, since the drug list you enter will not be saved, be sure to print it out before you leave the site.  Unfortunately you will have to reenter you drug list each time you want to do a plan search.

The most egregious aspect of this new function is the blatant push of users to Medicare Advantage plans.  There is a comparison of "costs" between original Medicare and Medicare Advantage.  How do I put this politely --- it is BS. The Medicare Advantage plans always show as cheaper!  Nor is the comparison showing a provider network comparison, prosthetic devices available, durable medical equipment restrictions, skilled nursing cost differentials and so on.  Reminder, Medicare is health insurance.  The operative word is insurance.  You get what you pay for whether it is house insurance, car insurance or Medicare insurance.

I recently talked to someone who is on a Medicare Advantage plan and had been happy for several years - when they were well.  However, the person was horrified at the cost of care when they got a diagnosis of cancer.  Suddenly, instead of a low cost copay of $35 to see a specialist, they had to pay $100 every time they went to the chemo treatment center.  They also had to pay a 20% coinsurance for the cost of an expensive chemo drug. This is a level of cost comparison that is not available in the plan finder function. The only way to know this level of detail is to look at the plan itself.  It is not easy to find but it can be done.  State health insurance assistance organizations (https://www.shiptacenter.org/) can help you ferret out those details.  For this person, they hadn't known to do it. The person was not exactly low income but couldn't afford their medical bills.  They also did not realize the plan's maximum out of pocket for the year is $5500 and that it would reset in January. They were desperate to find financial assistance and turned to local charities for help.  Just as a reminder, there are no hidden costs in original/traditional Medicare and no network restrictions.  It is very straight forward and, with a Medicare Supplement the maximum cost is very predictable.

The new plan finder is now available on medicare.gov but it is for 2019 plans, 2020 plans won't be loaded until the beginning of October.  Test it out and give CMS your feedback on it.

I do not know whether or how Via Benefits will modify their plan comparison function.  Reminder, their plan comparison function is only for the plans they sell.  If you want to look at all the plans available in your zip code you must use medicare.gov.